High personal costs of a medical career

High personal costs of a medical career

Monday 8 October 2018


It was 1983. My first job as a medical intern was at a major teaching hospital in Melbourne. “We are white collar workers. That means we don’t put in time sheets for overtime. Our consultants don’t!”


That was my introduction to working 100 hours a week and being paid for 70.


To put work ethic in context, the health minister told our graduating year group we were only in a training position. We weren’t registered doctors – yet. That our $32,000 gross annual income was a bonus.


I know I have to get over that! But, I resent that as a hardworking intern, resident and registrar, my rights to work in a safe environment were ignored. That no one cared when I fell asleep driving home after 14 hours of stressful work in the emergency department and woke up on the wrong side of the road. Or that the hours of unpaid time I gifted meant that I didn’t get to spend precious time with friends and family like other 23-year-olds.


I worked a one in two roster. Saturdays were a normal working day. I got every second Sunday off, until I did a Cardiology term. I had to admit patients for elective procedures on my day off. It was expected.


A number of my colleagues, some in senior administrative positions suicided quietly. Their needless deaths remain unchallenged.


The 1990s. Nothing much had changed. I was working at a major children’s hospital here in Western Australia. Rostered hours were intense, especially for intensive care and neonatal transports, when hours worked were averaged to minimise overtime paid.


Desperate to start a family, I committed to a job share position in Perth for 12 months. All was going well until I was forced to work full time for three months in the remote Pilbara region. Failure to comply meant I would not be able to complete my paediatric fellowship. I had no choice.

My older daughter can be grateful to this disruption in my timeline! Sometimes things are meant to be.


In 1998, I started my solo private paediatric practice. My second daughter was only eleven weeks of age. I was soon working up to 80 hours a week, which included unpaid on-call work in neonatal medicine. A bad decision, especially for a doctor working in the area of child and adolescent health. One, which stemmed from the unrealistic expectations of an engrained medical work ethic. Fortunately I had, and still have a very supportive husband and forgiving children.


The personal cost of my career, compounded with the same crazy work ethic of my medical husband has been high.


I recall one night, exhausted from long work hours, two young children sleeping, when my husband returned from a night emergency call.


He simply said, “We hit a roo on take off. Lucky it hit the nose of the aircraft and not a prop, or I wouldn’t be home with you now.”


I sometimes reflect on the sacrifices we make as doctors – never acknowledged or known by outside eyes. The hours we give graciously to care for others come at a cost. They take away the time we have to spend with our own families. They limit our own options to pursue interests in sport, drama, writing and music. Or, to work in our communities.


I have never done medicine for monetary gain. I have always given my heart and soul – my choice. To care and be kind. It is a privilege to look after children and young adults with great complexity.


But sadly, I no longer feel as valued, a sentiment expressed by many of my colleagues. Medicine has become more challenging. The emotional vicarious load is great. We could do with some kindness and compassion from our patients. And from colleagues! Not public shaming and vindictiveness on shared digital platforms.


Younger doctors have choice. This gives them power. The decisions they make must include a realistic family/work balance to survive the elevated bar of expectation placed on the medical workforce today.


Mentorship must support the passion of those who selflessly help others. It should also assist them to say ‘No’ when the burden of care is too high.


There are times when a doctor must choose family over patients. If they fail to do this, regret will follow them into retirement.

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"It is my hope that we can tackle the challenges our profession faces, united as one. If we dislike our working hours, our pay, gender inequality or low training opportunities, we can change these together. As a nurse in my previous life, I know that when a profession stands as one, people listen."
Dr Rebecca Cogan
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